21st Century Aging

Living longer and better.

Physicians Are Biased Against Overweight Women

Doctors think differently about those carrying extra pounds.

Being a patient in a medical office these days is hard, especially if you happen to be an overweight female.

A study found that more than 40% of doctors feel "frustrated" by obese patients. But feelings among doctors are not the only problem. Recent studies find that a woman who is as little as 13 pounds overweight may receive less than optimal medical care. Women who are over 20 pounds on the wrong side of the scale are more prone to inaccurate diagnoses, have more trouble finding a fertility doctor for help with getting pregnant, and are less likely to receive early diagnosis and effective treatment for cancer.

I suspect that part of the reason for this is that women have long been misunderstood and pathologized regarding physical symptoms. This labeling is worse when she is overweight and presents to her physician with complaints of pain. She often hears her physician reduce her problems solely to being heavy: “Lose some weight and you will feel better.”

Doctors think differently about those carrying extra pounds.

Of course, obesity is associated with a number of potential health problems. But there is something amiss here in terms of doctor empathy. Weight gain is partially related to self-control, but also genetic, biological and environmental factors.

Many physicians, whom we often wish would know us better, attribute being overweight solely to dietary habits, despite data that suggest food intake is not the only culprit. 

Psychotrophic drugs, which are taken by millions, cause people to put on pounds. Ironically, these medications are often prescribed by the very same doctors that are annoyed with their patients for being heavier than they should be. Additionally, though in need of further study, some have speculated on chemical and environmental factors that impact metabolism via hormone production. Finally, there is recent and daunting evidence that child abuse or neglect alters leptin and adiponectin—hormones that are vitally involved in weight regulation.

Surely, we would think, physicians are aware of this research.

Think again.

According to Wake Forest Medical Center, who reviewed published articles on this topic, “Of the 208 articles found, only five addressed ways to increase medical students’ knowledge, attitudes and skills regarding overweight and obesity treatment. Only two of those five addressed medical student bias toward obese patients, and just one dealt with attempting to change this bias.”

Add the paucity of training regarding nutrition in most medical schools and you have a pretty low bar in terms of expecting your physician to understand much of anything related to weight problems.

The only way to deal with this is to help our physicians understand that weight is a complicated biological, social, environmental and intrapersonal problem. Don’t tolerate a doctor who blames patients for being overweight. Find someone who can offer understanding, encouragement, and who realizes that different diets work for different bodies.

Managing weight is something no one should have to deal with alone. Finding the right medical team is vital when trying to lose pounds, just like it is for any other condition. If your doctor seems biased, look elsewhere.

 

 

Tamara McClintock Greenberg, Psy.D., M.S., is an Associate Clinical Professor of Psychiatry at the University of California, San Francisco.

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